History is riddled with stories of unimaginable cruelty. Related to us from the Greeks is the story of Herophilus, the father of anatomy, who gained his knowledge by vivisection; the practice of cutting up live humans for scientific research. Prisoners and convicts were the most common subjects.
In many ways we are mired by the ghosts of our past and these ghosts live with us today. In Nazi Germany, occupants of the concentration camps were tortured by all manner of horrific scientific experiments. The people interned at these camps were used as test subjects for everything from biological and chemical warfare to research into hypothermia.
The research gained from the undeniably horrific studies of the Nazis remains of great use to us today. What we know about hypothermia and our treatments of it come almost entirely from work done by Nazi scientists. This same research is used today by the American military in the interrogation of detainees abroad.
In America, prisoners were used as test subjects for 90% of pharmaceuticals up until 1970. These tests even included the testing of hallucinogenic and carcinogenic chemicals.
When the need arises for experimentation there is always a group that is singled out for testing. Today, we tend to see ourselves above our seemingly remote and barbaric past. We see it as a dark age of hopelessness and misery and the world today as infinitely better.
What we must realize is that any hope we have today, any progress we seem to have made, has come at a great price some time in the past. Millions have died in the aspiration of “bringing mankind forward” and often for nothing. After all, everything Herophilus learned from vivisecting living men and their suffering was lost when the Library of Alexandria burned.
All of this sets a dangerous precedent. The Hippocraic oath to do no harm has always been enigmatic. The question tends to become one of economics, whether it is better to save one life or at the cost of a single life to save many patients. If we look to our history we see that the medical barbarities are still with us today, and historically, doctors are only used to justify the cruelty.
Bedlam
Treatments for mental illness are a relatively new thing. What was done in the past is looked at today with a certain amount of shame and regret. Though the practice of lobotomy (surgical removal, alteration or damaging of certain areas of the brain) and electro-convulsive therapy (ECT) are generally looked down upon today – few realize they are still practiced.
Historically, much of what took place inside the so called “lunatic asylums” was never known to the outside world besides the deranged screams emanating from behind barred windows. Today, however, what went on in these mental hospitals is legendary.
Ten Days in a Madhouse
Nellie Bly, a young, aspiring journalist, was the first to expose the drama unfolding behind these closed doors. In 1887, she had herself committed to Blackwell’s Island Insane Asylum for Women. To do this, she went to a local boarding house and feigned amnesia and frightened the other women in the house by refusing to sleep and staring fixedly at the wall. Once committed, she gave up all appearances of insanity and acted as she would in everyday life.
To the surprise of Nellie Bly, her newly sane behaviour did not convince the doctors. To her amazement, the saner she acted the more the doctors felt that she was a hopeless case. In her book titled, “Ten Days in a Madhouse,” Bly describes the inhumane treatment of the wards of the state.
Bly describes cruel nurses, atrocious food, icy baths, inadequate clothing and heating in the cells which often led to poor health among the residents. Icy baths were considered a sort of shock therapy at the time, intended to jar a patient out of psychosis. Not surprisingly it often did more harm than good. She writes
“What, excepting torture, would produce insanity quicker than this treatment? ... Two months would make [the patient] a mental and physical wreck.”
Chemical Shock Therapy
The advent of insulin in 1922 saved the lives of countless diabetics and continues to do so today. When introduced however, it was found to have an unexpected penchant for treating schizophrenia, especially in the early phases. It was found that massive amounts could be administered to create seizures that would facilitate the recovery from mental illness.
The patient would be administered an overdose of insulin. This lowers blood sugar levels which are necessary for simple body functions and cognition; the result is called hypoglycaemic shock. The patient experienced confusion and excitement which gives way to a coma. The coma was allowed to persist for half an hour, then the patient would be given sugar intravenously after which he quickly recovers.
The seizures that resulted from overdoses would frequently make patients more manageable; this made the treatment popular in mental hospitals. The procedures were dangerous, however, because low sugar levels in the body can cause brain damage and death.
Metrazol was another wonder drug. Created in 1934, this drugs purpose was to create seizures in a person to facilitate a mental recovery. The seizures which would result from metrazol were often so violent that patients would break bones during the episodes. The drug fell out of wide use because it was found that Electroconvulsive Therapy, or ECT, had a similar effect without so many of the brutal side-effects of metrazol.
The Electric Cure
Electroconvulsive therapy, or ECT, was introduced to the world of abnormal psychology in the 1930s. It offered a new way to modify the behaviours of the patients suffering from mental disorders. The treatment was especially popular because of its tendency to pacify otherwise violent patients. In many cases ECT was used for control measures and punishment rather than as a treatment.
ECT works by passing an electrical current through a patient’s brain using electrodes placed on the head. The electrical current produces convulsions that cause a change in a person’s disposition. The current was thought to disrupt the physiological causes of mental illness in the patient’s brain. But even today, the reason for its efficacy is unknown.
ECT was used in a more primitive form some years before it came into wide use in the 1930s. After attending a demonstration by Benjamin Franklin in 1756, the famous Methodist minister, John Wesley wrote in his journal describing his excitement. He later wrote:
“I do not know of any remedy under heaven that is likely to do you so much good as the being constantly electrified.”
Wesley reported in his journal that Franklin’s static machine could be used to cure all manner of illness and promote general good health. Wesley even self treated with the machine when he came down with a respiratory infection that would not allow him to preach.
Since the 1930s the treatments have become increasingly robust but the principles remain the same. Electrical impulses in the brain to disrupt established patterns and make the subject more suggestible.
In the 1940s and 1950s the treatment was used like Wesley saw it, as a panacea. This treatment was used for many illnesses. Only “obsessional neurotic disorders” like OCD could not be treated with ECT as it tended to make the symptoms of neurotic illnesses worse.
ECT was tested for effectiveness for brainwashing and mind control in the 1960s. The Allain Memorial Hospital in Montreal led research in this new direction with the funding of the CIA. Only after the tests were revealed did this research end, at least publicly.
Today ECT is still used in limited cases for the treatment of severe depression. It is felt that, in cases where suicide or irrevocable damage is a risk, it is better to use this treatment than to risk the death of the patient.
From the days of Wesley onwards, ECT has been married with controversy. Since its wide use in the 1930s, doctors have denied that any long term damage results from the treatment while other groups have maintained that it immediately and permanently damages patients.
The medical community was almost unanimous in expressing the harmlessness of ECT until the year 2000, when the first longitudinal study was conducted of a large group of patients, both before and after treatment.
The study found that severe cognitive impairment often followed ECT treatments. IQ was reduced, amnesia occurred and, most notably, visual and verbal memory was shown to be significantly reduced. Ironically, some patients taking part in ‘self-report’ studies believed that their memory had actually improved after the treatments. Tests showed that the opposite, in fact, was the truth. Currently, at least 1 million people receive ECT every year.
The Clonic Tonic
It was formerly believed that shock therapies, be it drug induced or electrically induced, would cause a state of extreme suggestibility. By inducing seizures, the patient becomes psychologically weakened with greatly reduced inhibitions. The patient can no longer resist the will of the therapist and gives into his view of the world.
William Sargant writes in his book, “Battle for the Mind,” that emotional collapse is critical to create a lasting change in the human mind. It was believed that in order to cure a patient of mental illness he must undergo a complete mental shift.
Freud said that “affectless memories, memories without any release of emotion [are almost useless].” The psychotherapist must strive to create emotional tension in his subject and by releasing the tension, also relieve the psychotic symptoms of his patient.
After an emotional collapse of any type, a person is extremely suggestible. In a mental health context this means that after emotional collapse a patient is open to suggestion and change. Old fears and habits can be washed away and replaced with new, socially acceptable behaviour.
(Pavlov found that dogs formerly conditioned can be broken down and given new habits in much the same way as humans can. Through a trauma, be it punishment, castration, starvation, what have you – old conditioning can be washed away and new behaviour instilled. The changes are permanent and the dogs will carry such conditioning with them to the grave. I realise that human beings are not dogs but in the context of simple stimulus-response conditioning and behaviour modifications I feel the similarities are worth including.)
It is for these reasons that therapists seek to cause a seizure in their patient. The patient must be thrown off balance emotionally and psychologically so that new behaviours may be implanted. Seizures and changes in the physiology of the brain are what are required and, as we’ve seen, there are many ways to bring them about.
The Good Doctor...
When Nellie Bly had herself committed to Blackwell’s Island she saw all that went on there. For all her actions and bravery she could change nothing. Conditions in the institutes may change but the patients were consigned to psychological oblivion. Insulin, metrazol and ECT could do little for many of the patients. As a result the families of the mentally ill were often forced to abandon them to the wards indefinitely.
As time went on the populations in mental hospitals grew. In the 1930s, the crisis had reached a boiling point. An MD at the time, Dr Walter Freeman became overwhelmed by the number of mentally ill patients in state care. He wrote in his journal that he was “filled with a weird mixture of fear, disgust and shame.” The Grandson of the famous neurosurgeon William Keen, Freeman had aspirations of becoming a great doctor and set out to discover the source of mental illness.
He began by dissecting the brains of dead patients in the morgue of his hospital, looking for physical abnormalities that might be the cause. He found nothing. As Freeman’s research came to a close he came upon the work of a Portuguese physician, Dr Egaz Moniz. Moniz detailed the results of recovery in patients which had portions of the brain removed. In a process called “prefrontal leucotomy.” The surgeon would drill into the skull and scoop out portions of the frontal lobe in the brain. It was found that this could relieve the patient of anxiety, depression, aggression and a host of other emotions.
In 1936, Walter Freeman and surgeon James Watts became the first Americans to perform a prefrontal leucotomy. The patient was brought to the operating room and anaesthetised. Dr. Watts drilled into the skull and severed the frontal lobe from the rest of the brain under Freeman’s direction. The procedure involved severing specific areas of “white matter” (neural tissue) in the brain while leaving “grey matter” (blood vessels and the like) intact.
As far as the doctors were concerned, their first patient was a success. Alice Hammatt suffered from insomnia, anxiety and depression and was facing institutionalization. After her operation she showed no signs of anxiety and was successfully released from care.
Freeman and Watts performed a number of procedures on other patients with varying results. Many of the patients regressed to their former behaviours after 6 months. Additionally, Freeman’s patients were often permanently incapacitated; they lacked energy, ambition, they acted in a childish manner and were “uninhibited” (meaning they would go about without cloths, eat massive amounts of food, drink excessive alcoholic, etc.). About one third of the patients treated were helped by the procedure. Another third were relatively unaffected by it. And about a third were made worse or permanently damaged by the procedure. Three percent died on the operating table or shortly following lobotomy.
It’s important to note that lobotomy targets the frontal lobe of the brain, an area responsible for “executive functions.” Such executive functions include reason, planning, emotions, personality and understanding. A successful lobotomy has the effect of cutting these features off from the rest of the brain.
Even with the mixed results, Freeman went on with the hesitant blessing of the medical establishment. At the time it was seen as inappropriate for a doctor to publicly challenge or criticise another physician. Any public resistance he would have had from physicians was effectively wiped away.
He came under fire from Freudian psychotherapists for the procedure but he remarked that psychotherapy could do nothing for the patients he was treating. Psychotherapists, after all, could do nothing for schizophrenics or patients with obsessional neurosis (OCD). Freeman maintained that his procedure would be used only as a last resort – it would be used only on patients where all other methods had been tried and failed.
1946 marked a new era in Freeman’s treatment. After World War II, mental hospitals had an influx of patients coming out of military service abroad. Freeman developed a new technique for operating on the brains of mental patients. It would allow him to perform a lobotomy without the presence of a surgeon or anaesthesiologist and without an operating room. Freeman’s new procedure, called “transorbital lobotomy,” used an object similar to an ice pick (in fact, Freeman used actual ice picks for his first operations) which would be inserted between the eyelid and eye. The instrument would be placed against the orbital bone behind the eyes where the skull is thinnest and tapped through the bone with a hammer. Once inside the skull the instrument would be moved back and forth, like a windshield wiper, to sever connecting white matter while leaving blood vessels intact. This new procedure took 3 to 4 minutes to perform and allowed Freeman to lobotomize many patients in a single day. (Freeman’s personal record was 25 lobotomies in one day, a psychiatrist Freeman trained in the procedure once performed 75 lobotomies in one day.)
With Freeman’s success he grew in notoriety as well. The Washington Star called lobotomy, “one of the greatest surgical innovations of this generation.” The New York Times called it “Surgery of the Soul.” In 1949, any remaining resistance to lobotomy was washed away when Egaz Moniz, father of the prefrontal leucotomy, received the Nobel Prize in Medicine.
By this time, thousands of patients were being lobotomized every year. Psychotic symptoms were replaced with dull contentment. The sufferers of mental illness were pacified and mental hospitals were largely emptied of their patients.
Freeman kept on with his procedure advocating it for an ever widening array of symptoms. The procedure he once claimed was one of last resort had become a procedure he would perform anytime, anywhere.
One of Freeman’s later patients, a child named Howard Dully, was lobotomized because his step-mother claimed he was difficult and abnormal. Freeman’s report reads, “He objects to going to be bed, but then sleeps well, he does a good deal of daydreaming... I think it would be pretty much of a shame to wish Howard on anybody.” An earlier patient, Rosemary Kennedy, was sent to Freeman by her father because her behaviour was threatening to endanger the political career of her brothers. She never recovered from the operation and had to be placed in permanent state care.
Freeman advocated the use of lobotomy for housewives who were “incapable” of tolerating domestic living. It was advocated for children who misbehaved or were hyperactive. By the end of his career, Freeman felt that practically anything could be treated with lobotomy.
The Pharmaceutical Revolution
But Freeman’s time was short lived. In the 1950s, a host of antipsychotic drugs flooded the market and lobotomy fell out of grace. The medical establishment which once supported the procedure now abandoned it. One former supporter stated that lobotomy is “no more subtle than a gunshot to the head.”
Chlorpromazine was the first antipsychotic to gain approval and wide used. It was originally marketed as “a chemical lobotomy,” a selling point at the time.
Today the definitions of mental illness are so broad that almost anyone could be diagnosed with some mental illness. As a result, the “need” for new pharmaceuticals is on the rise.
The result is that a greater number of people are medicated for mental condition now than any time in the past. The situation is so dire that two thirds of adolescents in foster care are on psychotropic drugs in the United States. State Legislator Marie Parente suggests, “The state may be motivated to label children as mentally ill because of the reimbursement checks they receive from the federal government, which compensates Massachusetts for half of all Medicaid expenditures.” Before pharmaceuticals were involved, mental treatments were reserved for the mentally ill, today anyone is fair game.
Final Thoughts
What’s important to realize is that those things that are presented to us as a method of last resort will eventually be used everywhere. ECT became widely used as a punishment and control measure in mental hospitals rather than for treatment. In Freeman’s case, a procedure that was initially used where all other methods have failed becomes treated as a cure-all. I was recently told a story of a girl going in to see a doctor to have a prescription filled. She mentioned that she had an upcoming dentist appointment and was nervous about it and the doctor wrote her a prescription for a month’s worth of Ativan, an addictive antianxiety drug.
We must also question the ramifications of leaving so much social power in the hands of physicians. By granting a physician the power to medicate for mental illness we imply that the physician knows what normal is and has the right to enforce it. Historically, ethics and medicine don’t mix. In Nazi Germany physicians became “healers of the corpus of the race,” and were given the power of life and death; they didn’t hesitate to use that power. Today we give doctors power over the minds of men. They tell us what normal behaviour is, what normal thoughts are and they enforce this standard with a cornucopia of new pharmaceuticals.
The cause of mental illness should also be considered. In the novel, One Flew Over the Cuckoo’s Nest, Ken Kesey suggests that the reason for mental health problems is an inability to cope with the world as the patient sees it. It is a question of environment, then, and not just neural chemistry which is responsible for much of the mental illness seen today.
The danger I see today is that almost everyone can be classified as mentally ill under current guidelines. Doctors have proposed that woman with symptoms of PMS should take Prozac as a means of alleviating their symptoms. With the BBC reporting that Prozac had been found in Britain’s water supply it paints a rather frightening picture; MP Norman Baker told the BBC it looked like “a case of hidden mass medication upon the unsuspecting public.”
Arthur Koestler, the famous essayist and journalist, wrote that “self-assertive tendencies” (that is, acts of self preservation) were a mental illness inherent in the human race because they often lead to conflict. In “The Ghost in the Machine,” Koestler proposed that we are all victims of evolution and suggested a chemical means of remediation. To any free thinking individual, the spectre of physical control of the mind is one of the greatest nightmares of all.
“The human neocortex is the only example of evolution providing a species with an organ which it does not know how to use...
“The conclusions, if we dare draw them, are quite simple. Our biological evolution to all intents and purposes came to a standstill in Cro-Magnon days. Since we cannot in the foreseeable future expect the necessary change in human nature to arise by way of a spontaneous mutation, that is, by natural means, we must induce it by artificial means. We can only hope to survive as a species by developing techniques which supplant biological evolution.” – Arthur Koestler
________________________________________________________________________________________
References.
- William Sargant – Battle for the Mind
- Nellie Bly – Ten Days in the Madhouse
- Aldous Huxley – Brave New World Revisited
- Arthur Koestler – The Ghost in the Machine
- Lectures from Jack El-Hai at UC Berkeley
- PBS.com PBS Documentary, The Lobotomist
- Neuropsychopharmacology – The Cognitive Effects of Electroconvulsive Therapy in Community Settings
- BMJ.com British Medical Journal – Patients’ Perspectives on Electroconvulsive Therapy: systematic review
- Psychiatric Times – Concern About Psychotropic Drugs and Foster Kids by Stephen Barlas
- Boston Globe – Report grim on teens after foster care
- Ect.org – CIA Brainwashing Victims Seek Canadian Court Action
- www.alanwattsentientsentinel.eu
- The Daily Mail – how a tiny dose of Prozac may help relieve the misery of PMS
- BBC – Prozac ‘found in drinking water’
Questions or comments? Contact me at:
TheStoicWatchmanNewsletter@hotmail.com
Check out the new website
TheStoicWatchman.blogspot.com
Articles written by Thomas Dean
